Analysis of dosimetric characteristics of proton radiotherapy in 4 cases of breast cancer

doi:10.3760/cma.j.cn371439-20250217-00078

Journal of International Oncology ›› 2025, Vol. 52 ›› Issue (7): 448-454.doi: 10.3760/cma.j.cn371439-20250217-00078

• Dosimetric characteristics of proton radiotherapy • Previous Articles Next Articles

Analysis of dosimetric characteristics of proton radiotherapy in 4 cases of breast cancer

Li Chengqiang¹^,², Wang Yungang¹^,², Yu Yishan³, Wu Shizhang¹^,², Tao Cheng¹^,², Ma Xingmin¹^,², Dai Tianyuan¹^,², Duan Jinghao¹^,², Chen Jinhu¹^,², Bai Tong¹^,², Zhu Jian¹^,²()

¹Department of Radiation Oncology Physics，Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China
²Shandong Provincial Key Medical and Health Laboratory of Pediatric Cancer Precision Radiotherapy （Shandong Cancer Hospital），Jinan 250117，China
³Department of Radiation Oncology （Chest Section 3），Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China

Received:2025-02-17 Revised:2025-05-19 Online:2025-07-08 Published:2025-07-23
Contact: Zhu Jian E-mail:zhujian@sdfmu.edu.cn
Supported by:
National Science and Technology Major Project of China(2024ZD0519901);National Natural Science Foundation of China(12105160);National Natural Science Foundation of China(82172072);Key R&D Program of Shandong Province，China(2024CXPT084);Natural Science Foundation of Shandong Province of China(ZR2021QA099);Natural Science Foundation of Shandong Province of China(ZR2022QH188);Youth Innovation Team Development Plan of Shandong Universities(2024KJJ013);Shandong Provincial Young Science and Technology Talent Support Project(SDAST2024QTB034)

Abstract

Abstract:

Objective To explore the dosimetric characteristics of proton and photon radiotherapy in the treatment of breast cancer. Methods Four female breast cancer patients who needed radiotherapy at Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. The target area ranges of 4 patients were left-sided breast cancer with lymph node involvement，left-sided breast cancer with lymph node involvement and internal mammary node，right-sided breast cancer with lymph node involvement and internal mammary node and synchronous bilateral breast cancer. Intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） plans were designed respectively based on the prescribed dose in the target area and the limits of organs at risk （tomotherapy plan for bilateral breasts）. The conformity index （CI），homogeneity index （HI），gradient index （GI） and organs at risk doses were evaluated. The dosimetric characteristics of IMPT and photon radiotherapy were compared. Results Both IMPT and photon radiotherapy plans of the 4 breast cancer cases met the clinical dose requirements. The HI value of IMPT plans （0.10-0.14） was comparable to that of photon radiotherapy plans （0.10-0.12），and the average CI of the photon radiotherapy plans was 0.10 higher than that of the IMPT plans，and the average GI was 0.55 lower than that of the IMPT plans. The D_mean of ipsilateral lung and heart of IMPT was lower，especially in the low-dose area （V_0-3），which was significantly lower than the photon radiotherapy plans，D_mean of ipsilateral lung was reduced by 12.2%，6.1%，16.1% and 34.8%，respectively，D_mean of heart was reduced by 47.2%，57.0%，72.4% and 83.0%，respectively. The ipsilateral lung V₂₀ of IMPT was not lower than photon radiotherapy plans （unilateral breast： IMPT was 30.0%-34.0%，IMRT was 29.0%-35.9%）. Conclusions IMPT significantly reduces the D_mean to the ipsilateral lung and heart while ensuring dose coverage of the target in breast cancer，preventing more volume of surrounding normal tissues from being irradiated. However，IMPT does not show much more advantage than photon radiotherapy plans in the ipsilateral lung V₂₀.

Key words: Breast neoplasms, Radiotherapy, Proton therapy, Radiotherapy dosage

Li Chengqiang, Wang Yungang, Yu Yishan, Wu Shizhang, Tao Cheng, Ma Xingmin, Dai Tianyuan, Duan Jinghao, Chen Jinhu, Bai Tong, Zhu Jian. Analysis of dosimetric characteristics of proton radiotherapy in 4 cases of breast cancer[J]. Journal of International Oncology, 2025, 52(7): 448-454.

Figures/Tables 5

References 14

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序号	靶区位置	年龄（岁）	靶区范围	放疗计划及处方剂量
1	左侧	53	左侧胸壁加左侧锁骨上下淋巴引流区	IMRT：50 Gy/25 f；IMPT：50 Gy（RBE）/25 f
2	左侧	60	左侧胸壁加左侧内乳、锁骨上下淋巴引流区	IMRT：50 Gy/25 f；IMPT：50 Gy（RBE）/25 f
3	右侧	48	右侧胸壁加右侧内乳、锁骨上下淋巴引流区	IMRT：50 Gy/25 f；IMPT：50 Gy（RBE）/25 f
4	双侧	44	双侧乳腺并瘤床加量	TOMO：乳腺50.4 Gy/28 f、瘤床64.4 Gy/28 f；IMPT：乳腺50.4 Gy(RBE)/28 f、瘤床64.4 Gy（RBE）/28 f

剂量学指标	病例1（左侧乳腺）		病例2（左侧乳腺）		病例3（右侧乳腺）		病例4（双侧乳腺）
剂量学指标	IMRT	IMPT	IMRT	IMPT	IMRT	IMPT	TOMO	IMPT
靶区
CI	0.74	0.71	0.81	0.58	0.84	0.68	0.64（瘤床）/0.57（乳腺）	0.53（瘤床）/0.55（乳腺）
HI	0.12	0.14	0.13	0.13	0.10	0.10	0.10(瘤床)	0.10（瘤床）
GI	2.18	2.72	2.87	3.73	2.54	3.04	2.5（乳腺）	2.8（乳腺）
肺（左）
V₅（%）	53.9	58.7	49.6	52.8	1.8	0.0	29.6	28.5
V₂₀（%）	29.0	30.0	32.4	32.5	0.0	0.0	15.8	12.4
V₃₀（%）	23.3	17.2	22.2	21.0	0.0	0.0	11.1	6.1
D_mean[Gy/Gy（RBE）]	15.6	13.7	14.7	13.8	1.2	0.1	8.9	6.0
肺（右）
V₅（%）	0.2	4.1	0.8	0.3	58.1	57.1	37.6	31.8
V₂₀（%）	0.0	0.0	0.0	0.0	35.9	34.0	16.1	10.7
V₃₀（%）	0.0	0.0	0.0	0.0	26.6	21.0	10.8	3.9
D_mean[Gy/Gy（RBE）]	0.6	0.9	1.0	0.1	17.4	14.6	9.3	5.9
心脏
V₅（%）	13.7	15.3	40.1	16.5	26.9	4.6	19.7	4.9
V₁₀（%）	9.4	10.6	19.5	12.1	3.7	2.5	7.3	2.8
V₂₀（%）	7.5	4.6	11.0	6.6	0.0	0.7	3.5	0.8
D_mean[Gy/Gy（RBE）]	5.3	2.8	7.9	3.4	2.9	0.8	4.7	0.8
脊髓
D_max[Gy/Gy（RBE）]	31.4	19.1	29.2	24.8	26.5	26.2	1.1	0.0
body（cm³）
5%D_处方剂量	3 560	2 870	4 629	2 942	4 689	2 777	4 773	2 963
15%D_处方剂量	2 476	2 007	2 903	2 121	2 992	2 010	3 418	2 105
25%D_处方剂量	1 872	1 534	1 967	1 629	1 989	1 567	2 575	1 611

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Analysis of dosimetric characteristics of proton radiotherapy in 4 cases of breast cancer

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